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04020044CITY OF CUPERTINO?a' �' '' �d ` �� '�'��/v BUILDING DIVISION PERMIT ,R1�.�Q� , h v a, ,..,m,,,, afa t' -.,LDINGADDRESS: CONDITIONED AIR PERMITND04020044 OWNER'S NAME: - PERMIT ISSUE DATE 'NINE: SANITARY N OL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm Net 1 am go under p visions Of Chapter 9 (my m a... with Section 70043) ofDivialon Softhe Busirm professk sCOde.a day if is inmumre n r REPLACE FURNACE & A/C 211- Ir Lken�_ sears a Dam Contra 1 ARCHITECTS DEC ds nJ my plain shell M used u puM1lic rernNt MAR 1 9 200 Licensed professional OWNER -BUILDER DECLARATION 1 heathy el'0m I am exempt NO Canl.nCo License law for the BUILDING 7031.5,Business and Profession asiul Code:Any tiny or county rtaesa on s an re Cnre Illi press, m Willett mGU1R6 a permit whichfollowingre e a sig ed tatement the pplicshot, h Permit t prior m ins Issuance, also the applicant for such Permit Lfile a signed statement Law(Chapter 9 Sq. Ft. Floor Area Valuation ensedppursuant .hat me and Cade) or (commencingwith hereon7000) or Division) of alleged xmpton.Mynvi Nal he is exempt therefrom and the baso for the allegetl esemption. My violation of - APN Number Occupancy Type Secdon 7011.5 by any applicant for a permfit subjects the appfcml to a civil penally of not mart Nan Eve hundred della. ($500). ❑ 1. u owner of Ne pmpmy, m my employes wIN mgna u their sole compemsadmn, 7 • 00Re ulred Inspections will do Ncwodt and On aWervre is nolinnendedoroffeled forsale(Sec.70C4,Buineu and professions Code: The Conoecmes Limine Law dors not apply to an owner of q P Property who builds err improves Hereon, and who dura ace h work himself or through his own employes. provided thauuch improvements are mulmanded reoffered for ole. if, however, Ne building or improvement issold within can year of completion, the owner - builder will have the burden of proving Nal M did not build or improve for purpose of oak.). 1, as Owner of the property. am exclusively contracting with licensed contractors In consumer the project (Sec. 70x4. Business and Profusions Code:) The Commerne's Li. cense Law does not apply to an owner of property who builds or improver dmreon, gild who contracts for such projects, with a conuacmr(s) licensed pursuant m the Comtadoes Lkenu taw. 0 I are exempt under Sec. . B& P C for this rtuon Owner Dam WORKER'S COMPENSATION DECLARATION 1 hereby afEm under penalty of perjury One of the following declarations: 1 have and will maintain a Certifimm of Consent Inself-inaum for Worker's Compen- sation, an provided for by Section 37M of the labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance, an required by Section 77110 of HC l4bor Cade, for Ne ucc of Ne work for which Nu pcm111 is inti. My Worker' a pen lion In .tutee carrier and Policyynnu[rybyegVaam Or Cartier. alley No' � �( CERTIFI ATE OF EXEMPTION FR&WORKERS' COMPENSATION INSU (This section need not he completed ifthe permit is forone hundred dollars (5100) or nus.) 1 mnify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so an Or becamesubject to the Workers' Compensndon Laws of California Date Applicant NOTICE TO APPLICANT: If, afar making this Cenificaer of Exemption, you should become subject It, the Worker's C..M.tion provisions of On Labor Code, you must forthwith comply with such prcvisinu or Nis permil shall be dcemcd Iewkcd. CONSTRUCTION LENDING AGENCY 1 I hemby affirm that Hcm is a construction lending agency for the performance or On work for which this permit is tested (Sea 3097, Civ. C.) Lender's Name Lattices Address 1 certify that I have Nis application end cum Nat the above information is carred 1 agree m comply Ih I city and county ordinances end scam laws minting to cab acdo.mrpose&ncalivcs of Nis city mcnerr upon the an alton-mendonedian.and ri fy above-mentionree uctractlyon keep (We) agree m save, and kap harmless the City of Cupertino against / ad or ajudgments,costs rad xpcns. which may in any way emrvce Bina id Cily in nu seance of He g.m n f Nis permit. in PLI ANT UNDERST S AND WILL COMPLY WITH ALL 0 POINT Issued by: Date S E REG JLATIO 11 Re -roofs Type of Roof igna ofAppiic HAZAR OUS MATERIALS DISCLOSURE ' Will On applicant orf pre building Occupant store or handle hanrdous maternal by the Cupertino h inical Code. Chapter 9.11. and the Hcalth and Safety de. Section 25532(a)?All roofs shall be inspected prior to any roofing material being installed. imdefined ❑YesaWill If a roof is installed without first obtaining an inspection, I agree to remove the applicant o mum building occupant use contract or devic. which il haaardom air mom tan u defined by Ne Bay Arca Air Qualily Managemenl all new materials for inspection. "Min? ❑Yes Nu have mad the ha ousmeerriab reyuirtments under Chapar6.95Of the Califon of net &Safelycodc, dose 155115.25573 and 15534.1 undc.tsnd irN building rrently haat a m, Nat u u my mfponsimlily m notify He sup 1 of the currently uwlecn must mclprencomanccofa Ccnlfmerof Ocm y Signature of Applicant Date All roof coverings to be Class "B" or better ter err atmonsed again d CITY OF CUPERTINO' CO�i'�RAC,Tv t ot�vrn o ;,„ - iHOLDING DIVISION PERMIT ,t BUILDING ADDRESS: CONDITIONED AIR PERMITND.04020044 OW NER's NAME: PERMIT 65UB DATE 12 NE: SANITARY , OONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 barony affirm Net 1 em licenxd a der revisions of Chapter 9 (commencing with Secthm7IX" of sWSion 3o(le Buai Phrofcasions Code.md myliccnw is Ucull foci a 51 � � REPLACE FURNACE & A/C Lia.g Dem Cbm or A7CHITECTS fiB rtth Js allMuxJupunlco P Licenced Pmf o el OWNER -BUILDER DECLARATION I hereby mm that I am exempt from the Contractor's License Law for the following mason. (Section 7031.5, Business and Pmfcssions Code: Any city or county f which requires a Permit to construct. eller, improve, demolish, or repair any structure prior to its issuance, also requires the applicant forsuch permit to rite a signed soldmant Net W is licensed pursuant to the pmAslonsaf the Common's License Low (Charter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7080) of Division 3 of the Business and Professions CMe) or that he is exempt therefrom and the basis for dld alleged exemption. Any violation of 3 Maftfl tber 0 0 Occupancy e P Y EYP Section 7031.5 by any applicant for a permit Subjects the applicant to a civil penalty of not mom than five hundred dolls* ($500). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, Required Inspections - will do do, work, and Naswcmrt i* not intended proffered far sale (Sec. 7041, Business and Pmfessmas Code: The Cantrmmfs License law dean net apply m an owner of p roperty w ho builds or im proves thereon, and who does such wank himself or through his own employees, provided lssuch impmvemants art notinlended conflicted formic. IC however. the building or improvement is said within one year of completion, the owner. builder will have the burden of proving that he did not Wild or improve for purpose of oleJ. ❑ 1, as owner of the property. em exclusively contracting with licensed rontaCmrs to construct the project (See. 7044. Business and Professions Code:) The Contsanmr'S Li• cense law does not apply to an owner of property who builds or improves lemon. and, who conumm for such projects with a comrscmr(s) licensed pursuant to the Comrsom's License Law. ❑ I am exempt under Sec, ,B&PC for this reason Owner Dam WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury, one of le following decorations: I have and will maintain aCertificata of Covent to self -insure for WorkeM1Compes- -lion, as provided for by Section 3700 of the labor Code, for the performance of the .it for which this permit is issued. ❑ 1 have and will maintain Worker's Compeasadon Insurance, as required by Section 3700 of the Labor Code, for the performance of the werk for which this permit is Issued. My War 'SC mpenaedan lmm�nce certim and Policy mbar a2: Gassier. ` r a Yt�tPoli I y r SLG CERTIFICATE OFEXEMPTION PROM WORKERS' COMPENSATION INSURANCE (Has motion need not be completed If the permit Isfmoac hundroddollam (SIM) ar Ices.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner an a to become subject to the Workers' Compensation Laws of California. Data APPImmL NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should become subject to the Worker'* Compensation previsions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed mtmked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of ' dm work for which this Permit is issued (Sao. 3097, Co. C.) Lender's Name Lender's Address I comfy that 1 have mad this application and sum that the above information is correct. I agree m comply with all city and county ordinances and sold laws relating to building construction, and hereby autharien representatives of this city to enter upon the above-memioned property for inspection purpous (We) agree to save. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against mid City in consequence of the granting of this permit. APPLIC NT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURC a ULA NS. Re -roofs Type of Roof �" hR o IiwnVContractar Dem HAZARpOUS MATERIALS DISCLOSURE Wil applicant or future building occupantSmre orhandle harudous matedal as 40nad by a Cupertino Municipal Cade, Chapter 9.12, and the Health ad Safety code, seeders 25532(a)? Oyu ly kNo All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment m devices which It hamumus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. strict? ❑sacs 4No I have mad the hvardsms matarialsroyuiremcnts under Chapmrh.95 of the Califor- nia Health & SafelyCode.Sectimu25M5,25533 and25534.1 undersend thatirdm building does no currently have a Oxnard, hal i, is my respmxihilihy to rmtily dm acupanl of the reyvirs c hien a I be at prior m issuance ofa Conifmam of Occupancy. Signature Of Applicant Date All roof coverings to be Class "B" or better ownerman rizeaasard Date t COMMUNITY MANAGEMENT SERVICES. INCORPORATED October 7, 2003 Fay Chong 20590 Shady Oak Lane Cupertino, CA 95014 Re: Cupertino Countrywood Homeowners Association Dear Ms: Chong: The Cupertino Countrywood Board of Directors has approved your architectural request to install an air conditioner condenser unit on the front patio subject to: 1. The installation being performed by a licensed contractor. 2. Any necessary City of Cupertino permits being obtained. 3. Any damage or maintenance resulting from the air conditioner installation being your responsibility to repair. 4. The plumbing and electrical lines being enclosed in a duct that is painted to match the building. 5. The air conditioner being a quiet model compatible with a townhouse community and City noise ordinances. Thank you for submitting your architectural request to the Board of Directors. Sincerely, Community Management Services, Inc. Bob Soares, Senior Association Manager Cupertino�Countrywood Homeowners Association BS/ R ti00Z g p 3� cc:., Board of.Directors File: 4 ... ..V+; tiPI, C LiG��'1j7:3;3fSb. i':^6YUC`i ��:i.C•4 TJQ:i p(,( L'J° _'i.`.�s'ir �{d :�lb]J 3 (?."d:i LI FJ:"2.;i. e{,.�rrY?iT'�J i{��'7 F'f� jt. is fir'rl hl'>.'�q 1935 'Dry Creek Road, Suite 203 • Campbell CA • 95008-3631 • voice (408) 559-1977 • fax (408) 559-1970 0 I• CITY OF T CUPEf�-TING CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM l # APNiS'- d 3� Date: BUILDING BREMFURN Building Address: d 9 Owner's Name: Fa Cho Phone #:513 Qb.�(v Contractor: Phone: -. Co y �- a4 License #: 144s vtv,: -. Contact: Phone: Cupertino Business License #: Building`Permit Info: _ d BSEISMICRE E c Pl b Mech ob D pion: !� Seismic Commercial Residential Co ercial ❑ EPERMITFEE Elec Permit Issuance ELECTRICAL For Residential Ins llations: Mech Permit Issuance Attic ❑ 1" floor 2nd floor ❑ PPERMITFEE Adhere to min set back re uirement ❑ PLUMBING For Commercial Installations: Bldg Permit Fees Replacement same weight ❑ Additional weight (structural talcs) ❑ BPLANCHK Structural Calculations required for new installation ❑ BUILDING New installation Planning val Required ❑ Business License s of Pr ct: Type of Construction; Occupan y upr2� apappcu u / vnriaaorm u t+onoeo u / Sq.Ft.FlooTirear New Location ❑ Replacement ❑ Qty,if A6nlicable Fee M FPP llaerrir�f�nn U-- n__-- BENERGY Ener BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRI- 4N A/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING `T 6"'J -,. ,